Authorization for Release of Student Records
The undersigned hereby authorizes the Interstate 35 Community School District and any of its agents to release official student records of:
(Full Legal Name of Student) (Date of Birth)
(Name of Last School Attended) (Dates of Attendance)
The undersigned specifically authorizes the release of the following official student records of the above student: (If not records are specified, the undersigned authorized the release of all student records of the above student.)
The reason for the authorization __________________________________________________
____________________________________________________________________________
Copies of the records to be released are to be furnished to:
- the undersigned
- the student
- other (please specify) ____________________________________________________
The undersigned has the following relationship to the student:
_________________________________Signature ____________________________Date
_________________________________Address __________________City _____State
_________________________________Phone
Revised/Reviewed: February 25, 2019